Lower Genital Tract Dysplasia

Female Lower Genital Tract Dysplasia

Lower genital tract diseases are abnormal changes in the lower portion of the female reproductive system which includes the cervix, vulva and vagina. These abnormal changes are called pre-cancerous lesions or intraepithelial neoplasia.

Cervical Dysplasia

It is defined as an abnormal change in the surface of the cervix which is the lower part of the uterus that connects to the vagina.

Causes

Almost all cases of cervical dysplasia are caused by high-risk types of the Human Papillomavirus (HPV). It usually affects women of ages between 25 to 50, although it can occur at any age.

Risk factors

There are several risk factors associated with cervical dysplasia such as:

  • HPV infection
  • Sexuality history
  • Smoking
  • A weak immune system
  • Other sexually transmitted infections

Symptoms

Usually, women with cervical dysplasia don’t have any symptoms. Symptoms usually don’t start until the cervical dysplasia becomes cancer. Symptoms include:

  • Pelvic pain
  • Pain during intercourse
  • Vaginal bleeding after intercourse
  • Vaginal discharge with a foul odour

Diagnosis

There are two tests for cervical dysplasia-Pap test and HPV test. The pap smear test is performed during a pelvic exam. The American Cancer Society recommends starting cervical cancer screening at the age of 21, regardless of the age when a woman becomes sexually active.

If cervical dysplasia is suspected in the pap smear test, then your doctor will perform a thorough evaluation of the cervix with a colposcopy. In a colposcopy, the doctor will look at your cervix with an electric magnifying instrument to look for abnormal cells.

Treatment

Treatment for lower genital tract diseases depends upon the type and severity of the dysplasia. If you have been found to have severe cervical dysplasia, then the doctor will recommend removing the affected area of dysplasia. The two most common procedures for removing areas of dysplasia are the Loop Electrosurgical Excision Procedure (LEEP) or cold knife conisation.

The LEEP can be performed as an outpatient procedure or in the doctor’s room. The doctor will ask you to lie down on an examination table and put your feet in stirrups. Then an instrument called a speculum is inserted into the vagina to hold the vagina walls so that the doctor can view the inside of the vaginal walls and the cervix.

The cervix is numbed by injecting local anaesthesia in it. An electrically charged loop made of thin wire is inserted into the vagina and up to the cervix. The loop is passed across the cervix, removing the entire area of dysplasia.

Cold knife conisation is a minor surgery in which cone-shaped portion of the cervix is removed using a scalpel.

VAGINAL DYSPLASIA

It is also called vaginal intraepithelial neoplasia (VAIN) which starts inside the vagina. It is a condition in which the vagina undergoes abnormal changes.

VAIN is relatively rare than cervical dysplasia. It is typically found in women of 40 and 60 years, although it can occur at any age.

Symptoms and Risk Factors

Women with VAIN usually don’t have any signs. Risk factors associated with VAIN are:

  • Exposure to the drug DES while in the mother’s womb.
  • HPV infection
  • History of cervical dysplasia
  • History of cervical cancer
  • Tobacco use
  • The weak immune system from HIV

Diagnosis

During a pelvic exam, the doctor performs a thorough examination of the vagina to look for VAIN. If a doctor sees some abnormal changes, then the doctor will recommend a biopsy to confirm the diagnosis.

Colposcopy is also performed for a more thorough examination of the vagina.

Treatment

The low-grade VAIN goes away on its own. The doctor recommends frequent examinations with pap tests and colposcopy every few months to make sure that they don’t progress to high-grade VAIN or vaginal cancer.

Treatment options for VAIN include the following:

Laser ablation: It is a minor procedure performed in the operating room under anaesthesia. It uses a laser beam to burn away the VAIN.

Topical therapy: In this therapy, medicine is applied to the area of VAIN. The medication is used for several weeks.

Surgical excision: In this procedure, the area of VAIN along with a small margin of normal tissue surrounding the VAIN is removed.

Radiation: In severe cases, radiation is used to kill abnormal cells.

VULVAR DYSPLASIA

Vulvar Dysplasia also called Vulvar Intraepithelial Neoplasia (VIN), are abnormal changes in the skin of the vulva. The vulva includes the area outside of the opening of the vagina.

Symptoms

Women with VIN usually don’t have any symptoms, but the possible symptoms of VIN are:

  • Itching on the vulva
  • Visible changes in the colour of the skin of the vulva
  • Cracks or ulcers in the skin of the vulva
  • Growth on vulva skin that looks like a wart

Screening and Diagnosis

There are no screening tests for early detection of VIN. The diagnosis of VIN is made through a pelvic exam. The doctor performs a thorough examination of the vulva to look for VIN. If the doctor sees any abnormal changes, then he will perform a biopsy to confirm the diagnosis.

Treatment

Laser ablation: It is a minor procedure performed in the operating room under anaesthesia. It uses a laser beam to burn away the VIN.

Topical therapy: In this therapy, medicine is applied to the area of VIN. The medication is used for several weeks.

Surgical excision: In this procedure, the area of VIN along with a small margin of normal tissue surrounding the VIN is removed.

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